Pulmonary Oedema & Dexamethasone in Mountain Sickness

[Manish7]

Hello everyone reading it, can you just help me understanding why pulmonary oedema
occurs during mountain climbing ,when there is rapid ascent?
Also why Dexamethasone is used ,although not curative but palliative?

 

[Student100]

No one knows for sure what causes or predispose a person to HAPE.

As far as dexamethasone here is an article that briefly touches on that: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907615/

I've never heard of using it for pulmonary or cerebral edema before, it isn't well studied.

The rule of thumb is that descending to a lower alltuide is the best course of action.

 

[SW VandeCarr]

I've never heard of using it for pulmonary or cerebral edema before, it isn't well studied.

Really? I don't know your qualifications, but the fact that you never heard of it being used for cerebral edema indicates your lack of knowledge of the subject matter. Dexamethasone is fairly standard for cerebral edema in patients with brain tumors and has been for some time.

http://www.medscape.com/viewarticle/498465_3

 

[Student100]

Really? I don't know your qualifications, but the fact that you never heard of it being used for cerebral edema indicates your lack of knowledge of the subject matter. Dexamethasone is fairly standard for cerebral edema in patients with brain tumors and has been for some time.

http://www.medscape.com/viewarticle/498465_3

Can't see the article, are we talking about the same condition, HACE/HAPE?

 

[SW VandeCarr]

Can't see the article, are we talking about the same condition, HACE/HAPE?

Dexamethasone is indicated for HACE as well. Go to the first paragraph of Diagnosis and Treatment in this link. I don't know why you can't see my first link. It works for me.

http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-2-the-pre-travel-consultation/altitude-illness

 

[Student100]

Dexamethasone is indicated for HACE as well. Go to the first paragraph of Diagnosis and Treatment in this link. I don't know why you can't see my first link. It works for me.

http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-2-the-pre-travel-consultation/altitude-illness

How much is that just belief in it works and how much is hard science? I don't think it's well studied at all. I still stand by descent being the only real curative treatment.

https://blogs.commons.georgetown.ed...1-february-2006/high-altitude-cerebral-edema/

And the 9 or other studies all show mixed results.

 

[SW VandeCarr]

How much is that just belief in it works and how much is hard science? I don't think it's well studied at all. I still stand by descent being the only real curative treatment.

https://blogs.commons.georgetown.ed...1-february-2006/high-altitude-cerebral-edema/

And the 9 or other studies all show mixed results.

It's very difficult to study acute conditions like HAPE/HACE. The point is that it's known to work in cerebral edema generally. Here's a quote from your last link, just before conclusions.

"Though effective, dexamethasone is now rarely used prophylactically due to the significant dysphoria and the likelihood of a rebound case of altitude illness occurring with discontinued use of the drug.5 Nowadays it has a valuable role as an adjunctive therapy in the treatment of HACE. Johnson et al.12 theorized that dexamethasone may stabilize cerebral vascular integrity, thereby reducing vasogenic edema and lowering intracranial pressure, processes that both contribute to the clinical entity of HACE."

I do agree that getting the patient to a safe lower altitude quickly is the best treatment if it's possible.

EDIT: BTW, your statement was to the effect that you weren't aware of dexamethasone being used for pulmonary or cerebral edema. (bold mine).

 

[Gannet]

Buck Tilton in his 2002 fourth edition of Backcountry First Aid and Extended Care states the following about Severe Altitude Illness

Severe altitude illness may show up as High Altitude Pulmonary Edema (HAPE): constant shortness of breath, chest pain, productive cough, very fast heart rate. Or it may show up as High Altitude Cerebral Edema (HACE): severe headache unrelieved by rest or medication, bizarre changes in personality, perhaps coma. Or it may show up as both. The patient needs to Go Down. In addition to descent, the best treatment is supplemental oxygen. Treatment may also include:
1) the drug nifedipine (sold often as Procardia®) for HAPE
2) The drug dexamethasone (sold often as Decadron®) for HACE.
Consult your physician. If descent is delayed, use of the Gamow Bag®, a portable hyperbaric chamber that simulate descent, may save the patient's life. Do not use a Gamow Bag® instead of descent.

 

[Gannet]

From http://www.mayoclinic.org/diseases-conditions/pulmonary-edema/basics/prevention/con-20022485 states the following:

Preventing HAPE
If you travel or climb at high altitudes, acclimate yourself slowly. Although recommendations vary, most experts advise ascending no more than 1,000 or 2,000 feet (300 to 600 meters) a day once you reach 8,000 feet (about 2,400 meters). In addition, it's important to drink plenty of water to stay hydrated. The higher you ascend the more rapidly you breathe, which means you lose larger amounts of water in the air you exhale from your lungs.

Finally, although being physically fit won't necessarily prevent HAPE, people in good condition tend to be less stressed at high altitudes. However, just because you have hiked or skied at high altitude before doesn't protect you from HAPE. Taken 12 to 72 hours before you travel to a high altitude, the medication acetazolamide (Diamox) can help prevent HAPE. Consider continuing the medication for an additional few days if any signs of altitude sickness, especially headache or insomnia, occur.